Category Archives: Women’s Health

African-American and Latina girls are more than twice as likely as white girls to become pregnant before they leave adolescence, which continues to confound states.

By Teresa WiltzStateline

LaNita Harris of the Oklahoma City County Health Department explains two of the posters the department uses in its Teen Pregnancy Prevention program. Although teen pregnancy and birth rates have dropped the past two decades, states still face the reality that black and Latina teens are more than twice as likely as white teens to become pregnant. (AP)

It’s a problem once thought to be intractable, and yet pregnancy and birth rates for black and Latina teens have dropped precipitously in the past two decades—at a much faster clip than that of white teens.

Despite this, black and Latina girls are more than twice as likely as white girls to become pregnant before they leave adolescence.

This glass half-full, half-empty scenario is a dilemma that continues to confound states. The racial and ethnic disparities surrounding teen pregnancy are stubborn, often a cause and consequence of poverty and a complex array of societal factors.

Teen pregnancies are usually unplanned and come with a steep price tag, costing U.S. taxpayers up to $28 billion a year, according to the Office of Adolescent Health, which is part of the U.S. Department of Health and Human Services.

Some states like Mississippi have found innovative ways to tackle the problem by targeting specific populations, while others like Kansas are serving up bills that make it more difficult for teens to access sex education, which is a critical component of preventing pregnancy in adolescence, according to advocates such as the National Campaign to Prevent Teen and Unplanned Pregnancy. Continue reading →

The Obama administration often touts the health benefits women have gained under the Affordable Care Act, including the option to sign up for coverage outside of open enrollment periods if they’re “having a baby.”

But advocates complain the special insurance enrollment period begins only after a birth. As a result, uninsured women who learn they are pregnant outside of the regular three-month open enrollment period, which this year ended Sunday, can get stuck paying thousands of dollars for prenatal care and a delivery — or worse, going without care.

The special insurance enrollment period begins only after a birth.

The advocacy groups, including the March of Dimes, Planned Parenthood and Young Invincibles, are asking the administration to allow women to sign up whenever they become pregnant – a change opposed by the insurance industry. They say they’ve sought the change unsuccessfully for several years. Continue reading →

President Barack Obama hailed a landmark achievement in his State of the Union address last month: Teen pregnancies in the U.S. have hit an all-time low.

But the U.S. still has a teen birthrate of 31.2 per 1,000 teens, nearly one-and-a-half times the rate in the United Kingdom, which has one of the highest rates in Western Europe.

Colorado may have found a way to close the gap. The state’s teen birthrate dropped 40 percent between 2009 and 2013, driven largely by a public health initiative that gives low-income young women across the state long-acting contraceptives such as intrauterine devices (IUDs) and hormonal implants.

Colorado has a successful model for stemming teen pregnancies. But will state lawmakers continue paying for it?

Backed by $23.5 million from the Susan Thompson Buffett Foundation, Colorado attracted national recognition for its program after Democratic Gov. John Hickenlooper announced the results of a cost-savings study last summer.

The state saved $42.5 million in 2010 alone, an average return of $5.85 in avoided Medicaid costs for prenatal, delivery and first year of infant care for every $1 spent on the program.

More important, Hickenlooper said, the initiative “has helped thousands of young Colorado women continue their education, pursue their professional goals and postpone pregnancy until they are ready to start a family.”

According to program supervisor Greta Klingler, Illinois, Nevada, New Jersey, New York, Ohio, Virginia and Wisconsin have asked Colorado to share its techniques and lessons learned. Illinois is already adopting some of Colorado’s methods in a statewide Medicaid program for unwanted pregnancy prevention, she said. The U.S. Centers for Disease Control and Prevention is also seeking more details from Colorado.

Bill Albert, chief program officer at the National Campaign to Prevent Teen and Unplanned Pregnancy, pointed to the promise of state-based programs that rely on low-maintenance, highly effective methods of contraception coupled with good counseling.

“We’ve made progress, but if we’re going to continue making progress, efforts going forward will have to be as innovative and up-to-date as possible,” Albert said.

But Colorado’s program will end this June when its private grant runs out, unless lawmakers approve state funding to keep it going for another year. A $5 million funding bill was introduced this month with bipartisan sponsorship, but it won’t necessarily be an easy win, especially in the Republican-led state Senate. Continue reading →

By Nina Martin ProPublica

To say abortion opponents are feeling fired up in 2015 would be a massive understatement.

In their first week back at work, congressional Republicans introduced a sweeping prohibition on abortions after 20 weeks of pregnancy (H.R. 36, the Pain-Capable Unborn Child Protection Act), as well as bills that would ban sex-selective abortions, target funding for groups like Planned Parenthood, require abortion providers to have hospital admitting privileges, and let doctors and nurses opt out of providing abortion care, even in emergencies.

In the states, where the 2014 elections gave Republicans control of two-thirds of state legislative chambers, incoming lawmakers also have supersized their abortion agendas.

But abortion is just one issue on the minds of activists focused on reproductive rights. There’s also birth control, conscience clauses and personhood. Here are seven key trends and themes to watch for this year.

Though they continue to be overshadowed by less expensive, less effective birth control methods, long-acting reversible contraceptives such as intrauterine devices are gaining ground, according to an analysis of recently released federal data.

Nearly 12 percent of women who used contraceptives between 2011 and 2013 used IUDs or hormonal implants, according to a Guttmacher Institute analysis of data from the federal National Survey of Family Growth.

That made these long-acting products the third most popular form of reversible contraception, behind birth control pills (26 percent) and condoms (15 percent).

The use of long-acting forms of contraception has been increasing steadily, from 2.4 percent in 2002 to 8.5 percent in 2009, according to Guttmacher.

Long-acting contraceptives don’t require women to remember to use birth control every day or whenever they have sex.

That makes them one of the most effective forms of contraception, preventing pregnancy in more than 99 percent of cases. IUDs last for up to 12 years, depending on the type, while hormonal implants protect against pregnancy for up to three years. Continue reading →

Many states are approving new protections for pregnant workers, requiring employers to give them more or longer bathroom breaks, rest periods, light duty, job transfers, leave time or other accommodations.

By Marsha MercerStateline

Decades after a federal law banned discrimination against pregnant women in the workplace, some states are providing additional protections to pregnant workers who want to stay on the job.

After Congress passed the Pregnancy Discrimination Act in 1978, many state legislators thought the problem had been solved.

“Women should not have to choose between being a mother and having a job.”

But as the number of women in the workforce has increased—and more of them have stayed on the job through their pregnancies—they have encountered obstacles not covered by the federal law.

Recent federal court rulings that have sided with employers who support a narrow interpretation of the law have added fuel to efforts in state capitals.

“Women should not have to choose between being a mother and having a job,” outgoing Democratic Gov. Pat Quinn of Illinois said in August when he signed that state’s Pregnant Workers Fairness Act.

As of Jan. 1, employers in Illinois must provide pregnant workers who request them more or longer bathroom breaks, rest periods, light duty, job transfers, leave time or other accommodations, unless doing so creates an undue hardship for the employer.

“These are women who are healthy and want to continue working,” said Democratic state Sen. Toi Hutchinson, a sponsor of the Illinois bill. “They’re not looking to get out of work. What they want is a temporary accommodation.”

Eleven other states also have passed laws requiring employers to provide reasonable accommodations to pregnant workers. In 2014, laws took effect in Delaware, Minnesota, West Virginia and the District of Columbia. Since 2011, Alaska, Connecticut, Maryland and New Jersey also have approved laws. Continue reading →

The Vatican has an absolute prohibition on sterilization for the purposes of birth control. The U.S. Catholic bishops consider the procedure “intrinsically immoral,” on par with abortion.

Yet for years, Genesys Health System, a Catholic medical center near Flint, Mich., allowed doctors delivering babies there to tie the tubes of new mothers who wanted to ensure they never got pregnant again.

A toughening of Catholic medical directives could include enforcing a ban on tubal ligations.

Genesys’s policy wasn’t hard to fathom: Performing a tubal ligation immediately after childbirth is the long-established standard of care, especially if a woman is having a cesarean section.

“She’s already cut open — her tubes are right there,” said Sarah Ward Prager, an associate professor in obstetrics and gynecology and director of family planning at the University of Washington Medical School.

Subjecting a new mother to a second surgery carries “unnecessary risk,” Prager said. “It is simply unethical to say, ‘I’m going to make you come back to a different hospital to have another surgery in six weeks because the bishop says I can’t tie your tubes right now.”

Then, seemingly out of the blue, Genesys reversed course. Starting November 1, sterilization with the “direct” aim of preventing pregnancy — as opposed to for some other medical (“indirect”) reason — was banned.

Patients who had planned to have the procedure after childbirth were left scrambling; their irate doctors were, too.

Genesys won’t say why it allowed sterilizations to go on for so long or why it has forbidden them now. In a statement to ProPublica, the hospital acknowledged only that it had “updated its policy on tubal ligations to comply with current Church teaching.”

But this much is clear: The Genesys decision is almost certainly a sign of things to come. Continue reading →

The state gets a C+ and comes in at No. 22 on the 2014 Women’s Health Report Card, a list from the Alliance for a Just Society, a Seattle-based national network of economic justice organizations including the Washington Community Action Network.

New research suggests that teenagers are more likely to choose long-acting contraceptives when cost is removed from the equation. And free coverage of such methods is required by the health law.

But now, a study has found that free coverage of such methods too often still falls short.

Why is free coverage of long-acting contraceptives—which can prevent pregnancy from three months up to 10 years—still lacking for roughly 40 percent of women?

The study, published in the journal Contraception by the Guttmacher Institute, found that insurance coverage of contraceptives without cost sharing has improved markedly since the health law’s requirement became effective for most women in 2013.

But gaps in coverage remain. The Guttmacher researchers analyzed the experiences of 892 privately insured women who used prescription contraceptives between the fall of 2012, before the law’s provisions took effect for most women, and the spring of 2014.

It found that the proportion of women who paid nothing for their intrauterine devices increased from 45 percent to 62 percent during that time.

The proportion of women who had no cost sharing for injectable contraceptives grew from 27 percent to 59 percent. (There weren’t enough women using hormonal implants to include in the study.)

Some long-acting contraceptives such as IUDS can cost hundreds of dollars up front, putting them out of reach financially for some women unless insurance covers the cost. Continue reading →

Teenage girls who are given access to long-acting contraceptives such as IUDs or hormonal implants at no cost are less likely to become pregnant, according to a study in the New England Journal of Medicine released Wednesday.

The findings come just two days after the American Academy of Pediatrics recommended that health providers should consider IUDs and implants first when discussing contraception choices with teen girls.

Young women with access to these methods at no cost were almost five times less likely to get pregnant, five times less likely to give birth and four times less likely to have an abortion.

Although there are not as many teenage pregnancies as there once were — rates have been cut by more than half since 1991 — they still pose serious public health issues because of the costs associated with child birth and public assistance for young mothers.

These pregnancies can also stunt education and income opportunities for teenage moms.

As many as half to two-thirds of women who’ve undergone hysterectomies or are older than 65 years in the United States report receiving Pap tests for cervical cancer.

This prevalence is surprising in light of the 2003 U.S. Preventive Services Taskforce guidelines recommending that women discontinue Pap testing if they have received a total hysterectomy without a history of cervical cancer and if they are over age 65 years with ongoing and recent normal Pap test results.

Performing these unnecessary tests can result in stress for the patient, increased costs, and inefficient use of both provider and patient time, concludes a new study in the American Journal of Preventive Medicine.

“During this time of health care reform, we could probably use our resources more wisely,” said corresponding author Deanna Kepka, Ph.D., M.P.H., assistant professor at the University of Utah’s College of Nursing and Huntsman Cancer Institute. Continue reading →

Pregnant women who felt pressured to have a labor induction or cesarean section by their obstetrical care providers were significantly more likely to have these procedures, even if there was no medical need for them, suggests a new study in the journal Health Services Research.

Both cesarean deliveries and labor inductions continue to rise, accounting for about a third of births in the U.S.

While both procedures can be life saving for mothers and babies, previous studies have found that they can also increase the risk of poor health outcomes, such as respiratory problems for newborns and infections and death for mothers, as well as significantly increasing health care costs.Continue reading →

Women’s health groups are launching a counterattack againstsuggestions by several Republican Senate candidates that making birth control pills available without a prescription is the answer to the dispute over contraceptive coverage rules in the health law.

At least four Republicans running for the U.S. Senate have proposed over-the-counter pills in recent weeks, including Ed Gillespie in Virginia, Cory Gardner in Colorado, Thom Tillis in North Carolina and Mike McFadden in Minnesota.

All four have advocated the repeal of the Affordable Care Act and its requirement that most insurance plans cover all FDA-approved contraceptives for women.

“I think over-the-counter, oral by contraception (sic), should be available without a prescription,” Tillis said in a debate with Sen. Kay Hagan, D-N.C., last week. “If you do those kinds of things, you will actually increase the access and reduce the barriers for having more options for women for contraception.”

Infertility treatment is a numbers game in some respects: How many treatments will it take to conceive a child? And how much can you afford?

Even as insurance plans are modestly improving their coverage of such treatments, clinics and others are coming up with creative ways to cover the costs to help would-be parents reduce their risk for procedures that can run tens of thousands of dollars.

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